Information for teachers

How can arthritis affect school life?

Many people think arthritis only affects the older generation. But 1 in every 1,000 young people in the UK has arthritis.

Arthritis in young people can be complex. Its severity varies from one person to another, and someone's symptoms can alter greatly from day to day. Read more about the symptoms and treatment of juvenile idiopathic arthritis (JIA).

A caring and friendly school environment, and staff with positive, understanding and compassionate attitudes, will make a big difference for a young person with arthritis. The key is a genuine ethos of inclusion so that a young person with arthritis has an equal opportunity to participate fully in school life and reach their potential.

When a young person has arthritis

Growing up with a long-term (chronic) illness can pose many physical, emotional and practical obstacles. It’s important to meet early on with your pupil and their parents/carers to find out:

how the condition affects your pupil

what they need to make sure they have a positive school experience and what school staff can do to help

whether they want other pupils to know about their condition.

If a member of your pupil's rheumatology team can attend the meeting they can give you additional medical information and a professional perspective that could be important. The rheumatology team should work with your school to help you understand your pupil's medical condition and needs. Ideally this will include assessment and co-ordination by an occupational therapist, a physiotherapist or a rheumatology nurse specialist.

Your school will need to consider the practical implications of a young person’s arthritis and where necessary help out by making technical and practical alterations.

Difficulties during lessons

Most young people with arthritis can manage perfectly well, with help, in mainstream schools. Your pupil may not need extra help in class on a regular basis, but it’s still useful for you to know about their condition as growing up with a chronic condition can affect psychological well-being.

It's also important to understand that they may need time out of school for hospital and GP appointments, as well as during severe flare-ups of their arthritis.

If your pupil has more severe arthritis they may need long-term support.

Your pupil might not always be able to participate fully in PE and drama lessons. They might want to avoid some contact sports, such as rugby, for example.

It's a good idea to talk with your pupil and their parents about what activities they'd like to participate in and what activities they might need to opt out of.

Exercise is a crucial aspect of a young person's ongoing self-management of their arthritis. They will most likely have a physiotherapist who will discuss and plan a weekly exercise programme with them.

Effects on concentration

If your pupil is in pain, they may be moody, irritable and tired. This can reduce concentration and may be especially bad towards the end of the day.

If you think they're ever using their arthritis as an excuse to get out of doing work, raise it with them sympathetically at an appropriate time. Your pupil may be trying to communicate an unidentified problem with you.

Fatigue can be an overwhelming problem for young people with arthritis. It can be related to:

chronic pain

disturbed sleep

anaemia

the effects of inflammation.

Mobility

Getting to and from school/college, as well as around the building, may be difficult. Taking the stairs may cause problems.

Stiff joints, particularly in the morning, may sometimes make your pupil late for school. They may be stiff after a period of sitting and may move less quickly than others.

Carrying heavy bags can be difficult when the arthritis is active.

Effects on their body

Your pupil may find it hard to use their hands properly. They may have difficulty writing, managing tools or doing physical tasks like going to the toilet alone or doing up buttons.

If your pupil has eye complications (uveitis) related to their arthritis, they may have difficulty with their sight.

Many young people have issues around body confidence and this could especially be the case with young people with arthritis.

The disease can affect the shape and size of joints. Many young people with arthritis take steroids, which can lead to weight gain. If this leads to any teasing or bullying, this must be tackled immediately.

What practical support can I give?

Schools are legally obliged to provide equality of opportunity for all pupils. This means that schools must not discriminate against a pupil with a disability by giving them a level of teaching, support and access to facilities that would put them at a disadvantage to their peers.

Ensuring this doesn't happen may require the school to make some reasonable adjustments so pupils with arthritis can participate fully in school life.

Getting around

Painful and stiff joints can make movements slower or more difficult. Ask your pupil sensitively if they’d like any modifications put in place.

They might be worried about being singled out for special treatment, so be careful to help practically as much as possible and without making them feel awkward or upset at unwanted attention, especially when they're starting at a new school or college.

Be flexible about your pupil arriving late or leaving early and allow extra time or help for moving between lessons. This is more of an issue in secondary schools and colleges, where lessons are often in different rooms.

Where possible, arrange for lessons to be in downstairs classrooms. If this isn't possible, let them use lifts where available. If necessary, give them a lift pass. Think about access for wheelchairs and crutches where necessary.

Give your pupil a ground-floor locker or let them leave textbooks in a secure place. If possible, give them two sets of books, one for school and one for home, so they don't have to carry them around.

Be flexible about uniform rules where there are specific needs, for example with footwear.

Give them a pass which explains any special provisions to avoid them having to repeatedly explain their needs or get in trouble. This could include, for example, a toilet pass, late pass, shoe pass, lift pass and inside break pass.

Avoiding stiffness

Let your pupil get up and walk around in class to help reduce stiffness. If they feel self-conscious about this, you could give them a task to do, such as taking a letter to the school office if it’s not too far away.

Have a quiet word with them if you think they seem uncomfortable and ask if there’s anything they’d like to do.

Using special equipment and modifications

Specially adapted equipment may be useful. Desks and chairs could be raised or lowered to provide the best seating and working position. Your pupil may want a chair during assembly or carpet time, however, if they feel self-conscious this should be done with tact. Back rests, foot supports and book rests could all help.

Providing your pupil with special thick pens and/or pencils might help them to write easier.

Install a rail in toilets or a banister on both sides of stairs.

Adapting activities

Think creatively about adapting activities in PE and drama to make it less demanding for your pupil and encourage them to join in.

You can get advice and guidance around these issues from your pupil, their parents and their physiotherapist or occupational therapist.

Arranging school trips

When arranging a school trip you need to carefully consider the needs of the young person with arthritis. Visit the area before the trip to reduce risk and assess access.

Speak with your pupil and their parents before the trip to tell them about the timetable and find out what they hope to get involved with. Talking about medication and any other medical information would help.

Be creative with the activities and try to make your pupil feel like they're not missing out. If there are physical activities, including long walks, try to plan alternatives.

Make sure that comfortable transport with regular breaks is provided. The accommodation should have good access and possibly either bedrooms on the ground floor or lifts if needed.

Sharing timetables

Young people with arthritis will need time out of school for regular hospital appointments to monitor their condition. Some may occasionally stay in hospital for tests or treatment, or occasionally for surgery if their condition is severe.

If your pupil does need to spend time in hospital, a shared timetable can be useful. Your school can work with the hospital school to arrange a part-time schedule.

For example, your pupil could have a mixture of being taught in school and through home teaching from a local service provider. This would stop them missing too much work and being left behind, and would let them see friends.

Hospital or home tutors will organise work from the National Curriculum. Ideally this should be arranged with your school to make sure your pupil can carry on with what they've been learning. If possible, arrange for your pupil to take work into hospital or home.

If your pupil has been very ill and in hospital for long periods, a discharge-planning meeting or case conference may be held. It’s very helpful if a member of school staff can take part in these meetings.

Hospital schools don’t cater for post-16 education, so if you're a sixth-form or college tutor you'll need to be directly involved with your pupil, their family and rheumatology team, particularly if your pupil is admitted to an adult hospital.

Making arrangements for examinations and course work

Some young people may need extra consideration for examinations, such as extra time or the use of a computer or scribe. This will almost certainly involve being in a separate room under exam conditions.

These accommodations need to be requested well in advance from the relevant examination board. Your pupil's rheumatology team will probably need to provide a letter of support.

If your pupil finds writing and typing difficult they may struggle with course work. Talk to them about this in plenty of time before deadlines and see if there is anything they need that the school can provide. Speech recognition software on a laptop may really help the young person when they're working on essays and course work.

Ensuring that a form tutor or another assigned teacher regularly checks that the pupil is up to date with school work, course work deadlines and revision timetables would be a very good idea. Encouraging the child to raise any concerns they have about exams and course work, in a timely fashion, is important.

Giving career advice

Most young people with arthritis do well academically and go on to college or university. Securing a job may be more difficult, however, due to many factors, including:

limited work experience

careers advisors and potential employers having unnecessarily low aspirations for the young person.

Improving employability is essential. Teachers and careers advisors can play a key role in this. Early work experience which matches your pupil’s strengths and ensures success can:

boost their self-confidence

improve their CV

help them realise their strengths and difficulties

give them a realistic insight into the world of work.

Careers advisors in schools and colleges can seek additional support from the rheumatology team.

Good careers advice for young people with arthritis will be a realistic and positive focus on what they can do, rather than what they can’t do.

Encouraging your pupil to be ambitious and confident is important. There will be life skills that the young people will most probably have developed from their condition - these may include:

being organised

being determined to overcome challenges and obstacles

showing resilience

thinking creatively to overcome problems.

It would be good to stress to the young people that these are skill sets that could be transferrable to the world of work which they should tell future employers about.

What emotional support can I give?

Growing up with a chronic illness and managing any limitations caused by arthritis can be tough and affect emotional well-being. Young people with arthritis will share the normal anxieties of their peers but may have additional concerns related to their condition and what might happen in the future.

The illness can affect the whole family and schools will need to be aware of the needs of siblings too. A Pastoral Support Plan (PSP) may be useful for some.

Making the most of playtime and breaks

Play and leisure time is an essential part of school life, to develop friendships and peer support. It also allows young people to let off steam and promote positive emotional well-being.

It’s important that young people with arthritis are encouraged and enabled to join in with their classmates during playtimes or breaks.

Exercise is good for arthritis and joining in will help your pupil to avoid feeling different. Sometimes, however, they may find running about or standing around in cold weather difficult, so you might occasionally let them and some of their friends play inside for some or all of break-time.

If it's possible, seats and sheltered areas of the playground would help your pupil and would probably be used by a lot of other children as well.

Deciding whether to tell classmates

Telling people about a chronic illness is a very personal decision. A young person with arthritis needs to be made aware of the potential advantages and disadvantages of telling people, so they can make an informed decision. This can provide young people with a larger support network and greater confidence.

A young person with arthritis may need to be equipped with the skills and confidence to tell people about their condition.

If your pupil wishes to keep details of their condition to themselves and not tell their classmates, or just tell a selected number of friends, that is a decision that should be respected.

If your pupil has to spend some time out of school because of their condition or treatment, they'll probably find it difficult to reintegrate with their class at first. Sensitive handling of this situation and encouraging classmates to be kind and understanding, without making too much of a fuss, would be really helpful.

Who am I and what can I do?

I'm AVA, the Arthritis Virtual Assistant, and I'm being trained by Versus Arthritis to give you general information about your condition and how to manage your symptoms. I can suggest exercises and tell you about medication.

How do I work?

I've been built using artificial intelligence powered by IBM Watson, and I learn and improve through every conversation. Whenever you use me, you're indirectly helping another person get the answers they need.

What can you ask?

I respond best to clear, simple questions about one type of arthritis. For example, "What exercises should I do?" or "How can I help myself?"

What if I want to speak to a real person?

If you need help from a real person here at Versus Arthritis, you can call our free helpline on 0800 5200 520.

Are you sure you want to close your conversation?

Your conversation will not be visible the next time you visit the Arthritis Virtual Assistant. If you want to keep a copy of the advice you've been given, you can print it using the button at the top of the chat window.